Abstract
Individuals with autism spectrum disorder (ASD) often have co-morbid anxiety and depression. Alexithymia and emotion regulation difficulties are commonly seen in individuals with ASD and in mood disorders. We hypothesized that alexithymia and emotional regulation would mediate the relationship between autistic features and anxiety/depression symptom severity. We collected data about emotional regulation, alexithymia, autistic symptoms and depression/anxiety in a sample of 64 young adults with ASD. We constructed two serial multiple mediator models, using autistic features as the independent variable and anxiety/depression symptoms as outcome variables. The serial relationship between alexithymia and emotional regulation mediated associations between autistic features and depression and anxiety, separately. The findings suggest that targeting alexithymia may benefit therapies designed to alleviate mood disorders in ASD.
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References
Ainslie Rosbrook, K. W. (2010). Autistic traits in the general population: What mediates the link with depressive and anxious symptomatology? Research in Autism Spectrum Disorders, 4, 415–424.
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181.
APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Armstrong, A. R., Galligan, R. F., & Critchley, C. R. (2011). Emotional intelligence and psychological resilience to negative life events. Personality and Individual Differences, 51(3), 331–336. https://doi.org/10.1016/j.paid.2011.03.025.
Ashburner, J., Ziviani, J., & Rodger, S. (2010). Surviving in the mainstream: Capacity of children with autism spectrum disorders to perform academically and regulate their emotions and behavior at school. Research in Autism Spectrum Disorders, 4(1), 18–27. https://doi.org/10.1016/j.rasd.2009.07.002.
Aust, S., Hartwig, E. A., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma-Theory Research Practice and Policy, 5(3), 225–232. https://doi.org/10.1037/a0027314.
Bagby, R. M., Ayearst, L. E., Morariu, R. A., Watters, C., & Taylor, G. J. (2014). The internet administration version of the 20-item Toronto alexithymia scale. Psychological Assessment, 26(1), 16–22. https://doi.org/10.1037/a0034316.
Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto alexithymia scale–I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32.
Barnhill, G. P., & Smith-Myles, B. (2001). Attributional style and depression in adolescents with Asperger syndrome. Journal of Positive Behaviour Interventions, 3, 175–183.
Becerra, R., Cruise, K., Murray, G., Bassett, D., Harms, C., Allan, A., et al. (2013). Emotion regulation in bipolar disorder: Are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders? Open Journal of Psychiatry, 3, 1–7.
Bernhardt, B. C., Valk, S. L., Silani, G., Bird, G., Frith, U., & Singer, T. (2014). Selective disruption of sociocognitive structural brain networks in autism and alexithymia. Cerebral Cortex, 24(12), 3258–3267. https://doi.org/10.1093/cercor/bht182.
Berthoz, S., & Hill, E. L. (2005). The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. European Psychiatry, 20(3), 291–298. https://doi.org/10.1016/j.eurpsy.2004.06.013.
Bilotta, E., Giacomantonio, M., Leone, L., Mancini, F., & Coriale, G. (2015). Being alexithymic: Necessity or convenience. Negative emotionality x avoidant coping interactions and alexithymia. Psychology and Psychotherapy, 4, 5. https://doi.org/10.1111/papt.12079.
Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3, e285. https://doi.org/10.1038/tp.2013.61.
Bolte, S., Poustka, F., & Constantino, J. N. (2008). Assessing autistic traits: Cross-cultural validation of the social responsiveness scale (SRS). Autism Research, 1(6), 354–363. https://doi.org/10.1002/aur.49.
Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the depression anxiety stress scales (DASS) in clinical samples. Behaviour Research and Therapy, 35(1), 79–89.
Campbell, D. W., & McKeen, N. A. (2011). Alexithymia tendencies and mere exposure alter social approachability judgments. Journal of Personality, 79(2), 335–358. https://doi.org/10.1111/j.1467-6494.2010.00687.x.
Connelly, M., & Denney, D. R. (2007). Regulation of emotions during experimental stress in alexithymia. Journal of Psychosomatic Research, 62(6), 649–656. https://doi.org/10.1016/j.jpsychores.2006.12.008.
Constantino, J. N., & Gruber, C. P. (2012). Social responsiveness scale-second edition (SRS-2). Torrance: Western Psychological Services.
Cook, R., Brewer, R., Shah, P., & Bird, G. (2013). Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychological Science, 24(5), 723–732.
Corden, B., Chilvers, R., & Skuse, D. (2008). Avoidance of emotionally arousing stimuli predicts social-perceptual impairment in Asperger’s syndrome. Neuropsychologia, 46(1), 137–147. https://doi.org/10.1016/j.neuropsychologia.2007.08.005.
Crawford, J. R., & Henry, J. D. (2003). The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42(Pt 2), 111–131. https://doi.org/10.1348/014466503321903544.
Dalbudak, E., Evren, C., Aldemir, S., Coskun, K. S., Yildirim, F. G., & Ugurlu, H. (2013). Alexithymia and personality in relation to social anxiety among university students. Psychiatry Research, 209(2), 167–172. https://doi.org/10.1016/j.psychres.2012.11.027.
Fernandez-Berrocal, P., Alcaide, R., & Extremera, N. (2006). The role of emotional intelligence in anxiety and depression among adolescents. Individual Differences Research, 4, 1.
Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. https://doi.org/10.1007/s10803-008-0674-3.
Grabe, H. J., Frommer, J., Ankerhold, A., Ulrich, C., Groger, R., Franke, G. H., et al. (2008). Alexithymia and outcome in psychotherapy. Psychotherapy and Psychosomatics, 77(3), 189–194. https://doi.org/10.1159/000119739.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. https://doi.org/10.1080/1047840x.2014.940781.
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348.
Harms, M. B., Martin, A., & Wallace, G. L. (2010). Facial emotion recognition in autism spectrum disorders: A review of behavioral and neuroimaging studies. Neuropsychology Review, 20(3), 290–322. https://doi.org/10.1007/s11065-010-9138-6.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: The Guilford Press.
Hayes, A. F., & Matthes, J. (2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41(3), 924–936. https://doi.org/10.3758/BRM.41.3.924.
Helles, A., Gillberg, I. C., Gillberg, C., & Billstedt, E. (2017). Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity. Autism, 21(4), 458–469. https://doi.org/10.1177/1362361316650090.
Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229–235.
Hogeveen, J., Bird, G., Chau, A., Krueger, F., & Grafman, J. (2016). Acquired alexithymia following damage to the anterior insula. Neuropsychologia, 82, 142–148. https://doi.org/10.1016/j.neuropsychologia.2016.01.021.
Honkalampi, K., Hintikka, J., Tanskanen, A., Lehtonen, J., & Viinamaki, H. (2000). Depression is strongly associated with alexithymia in the general population. Journal of Psychosomatic Research, 48(1), 99–104. https://doi.org/10.1016/S0022-3999(99)00083-5.
Karukivi, M., Hautala, L., Kaleva, O., Haapasalo-Pesu, K. M., Liuksila, P. R., Joukamaa, M., et al. (2010). Alexithymia is associated with anxiety among adolescents. Journal of Affective Disorders, 125(1–3), 383–387. https://doi.org/10.1016/j.jad.2010.02.126.
Laloyaux, J., Fantini, C., Lemaire, M., Luminet, O., & Laroi, F. (2015). Evidence of contrasting patterns for suppression and reappraisal emotion regulation strategies in alexithymia. The Journal of Nervous and Mental Disease, 203(9), 709–717. https://doi.org/10.1097/NMD.0000000000000353.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.
Lougheed, J. P., & Hollenstein, T. (2012). A limited repertoire of emotion regulation strategies is associated with internalizing problems in adolescence. Social Development, 21(4), 704–721.
Loveland, K. A., Tunalikotoski, B., Pearson, D. A., Brelsford, K. A., Ortegon, J., & Chen, R. (1994). Imitation and expression of facial affect in autism. Development and Psychopathology, 6(3), 433–444. https://doi.org/10.1017/S0954579400006039.
Lovibond, P. F., & Lovibond, S. H. (1995a). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343.
Lovibond, S. H., & Lovibond, P. F. (1995b). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.
Lugnegard, T., Hallerback, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32(5), 1910–1917. https://doi.org/10.1016/j.ridd.2011.03.025.
Lyall, K., Croen, L., Daniels, J., Fallin, M. D., Ladd-Acosta, C., Lee, B. K., et al. (2017). The changing epidemiology of autism spectrum disorders. Annual Review of Public Health, 38, 81–102. https://doi.org/10.1146/annurev-publhealth-031816-044318.
Mankus, A. M., Boden, M. T., & Thompson, R. J. (2016). Sources of variation in emotional awareness: Age, gender, and socioeconomic status. Personality and Individual Differences, 89, 28–33. https://doi.org/10.1016/j.paid.2015.09.043.
Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., et al. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52(7), 679–688. https://doi.org/10.1016/j.jaac.2013.05.006.
Naghavi, F., & Redzuan, M. (2012). The theoretical framework and application on the relationships between family functioning, alexithymia and emotional intelligence among early adolescents. Life Science Journal-Acta Zhengzhou University Overseas Edition, 9(1), 764–770.
Onur, E., Alkin, T., Sheridan, M. J., & Wise, T. N. (2013). Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder. Psychiatric Quarterly, 84(3), 303–311. https://doi.org/10.1007/s11126-012-9246-y.
Panayiotou, G., Leonidou, C., Constantinou, E., Hart, J., Rinehart, K. L., Sy, J. T., et al. (2015). Do alexithymic individuals avoid their feelings? Experiential avoidance mediates the association between alexithymia, psychosomatic, and depressive symptoms in a community and a clinical sample. Comprehensive Psychiatry, 56, 206–216. https://doi.org/10.1016/j.comppsych.2014.09.006.
Pandey, R., Saxena, P., & Dubey, A. (2011). Emotion regulation difficulties in alexithymia and mental health. Europe’s Journal of Psychology, 7(4), 604–623.
Parker, J. D. A., Taylor, G. J., & Bagby, R. M. (2001). The relationship between emotional intelligence and alexithymia. Personality and Individual Differences, 30(1), 107–115. https://doi.org/10.1016/S0191-8869(00)00014-3.
Parker, J. D., Taylor, G. J., & Bagby, M. (2003). The 20-Item Toronto alexithymia scale III. Reliability and factorial validity in a community population. Journal of Psychosomatic Research, 55, 269–275. https://doi.org/10.1016/S0022-3999(02)00578-0.
Petrides, K. V., Mikolajczak, M., Mavroveli, S., Sanchez-Ruiz, M. J., Furnham, A., & Perez-Gonzalez, J. C. (2016). Developments in trait emotional intelligence research. Emotion Review, 8(4), 335–341. https://doi.org/10.1177/1754073916650493.
Poquerusse, J., Pastore, L., Dellantonio, S., & Esposito, G. (2018). Alexithymia and autism spectrum disorder: A complex relationship. Frontiers in Psychology, 9, 1196. https://doi.org/10.3389/fpsyg.2018.01196.
Reszka, S. S., Boyd, B. A., McBee, M., Hume, K. A., & Odom, S. L. (2014). Brief report: Concurrent validity of autism symptom severity measures. Journal of Autism and Developmental Disorders, 44(2), 466–470. https://doi.org/10.1007/s10803-013-1879-7.
Ritschel, L. A., Tone, E. B., Schoemann, A. M., & Lim, N. E. (2015). Psychometric properties of the difficulties in emotion regulation scale across demographic groups. Psychological Assessment, 27(3), 944–954. https://doi.org/10.1037/pas0000099.
Rosbrook, A., & Whittingham, K. (2010). Autistic traits in the general population: What mediates the link with depressive and anxious symptomatology? Research in Autism Spectrum Disorders, 4(3), 415–424.
Ruganci, R. N., & Gencoz, T. (2010). Psychometric properties of a Turkish version of the difficulties in emotion regulation scale. Journal of Clinical Psychology, 66(4), 442–455. https://doi.org/10.1002/jclp.20665.
Rusch, S., Westermann, S., & Lincoln, T. M. (2012). Specificity of emotion regulation deficits in social anxiety: an internet study. Psychology and Psychotherapy, 85(3), 268–277. https://doi.org/10.1111/j.2044-8341.2011.02029.x.
Samson, A. C., Hardan, A. Y., Lee, I. A., Phillips, J. M., & Gross, J. J. (2015). Maladaptive behavior in autism spectrum disorder: The role of emotion experience and emotion regulation. Journal of Autism and Developmental Disorders, 45(11), 3424–3432. https://doi.org/10.1007/s10803-015-2388-7.
Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion, 12(4), 659–665. https://doi.org/10.1037/a0027975.
Sifneos, P. E. (1994). Affect deficit and alexithymia. New Trends in Experimental & Clinical Psychiatry, 10(4), 193–195.
Swain, D., Scarpa, A., White, S., & Laugeson, E. (2015). Emotion dysregulation and anxiety in adults with ASD: Does social motivation play a role? Journal of Autism and Developmental Disorders, 45(12), 3971–3977. https://doi.org/10.1007/s10803-015-2567-6.
Swart, M., Kortekaas, R., & Aleman, A. (2009). Dealing with feelings: Characterization of trait alexithymia on emotion regulation strategies and cognitive-emotional processing. PLoS ONE, 4(6), e5751. https://doi.org/10.1371/journal.pone.0005751.
Taylor, G. J. (1984). Alexithymia: concept, measurement, and implications for treatment. American Journal of Psychiatry, 141(6), 725–732.
Venta, A., Hart, J., & Sharp, C. (2013). The relation between experiential avoidance, alexithymia and emotion regulation in inpatient adolescents. Clinical Child Psychology and Psychiatry, 18(3), 398–410. https://doi.org/10.1177/1359104512455815.
Volkmar, F. R., Jackson, S. L. J., & Hart, L. (2017). Transition issues and challenges for youth with autism spectrum disorders. Pediatric Annals, 46(6), e219–e223. https://doi.org/10.3928/19382359-20170519-03.
Wigham, S., Barton, S., Parr, J. R., & Rodgers, J. (2017). A systematic review of the rates of depression in children and adults with high-functioning autism spectrum disorder. Journal of Mental Health Research in Intellectual Disabilities, 10(4), 267–287. https://doi.org/10.1080/19315864.2017.1299267.
Zlomke, K. R. (2009). Psychometric properties of internet administered versions of Penn State Worry Questionnaire (PSWQ) and depression, anxiety, and stress scale (DASS). Computers in Human Behavior, 25(4), 841–843. https://doi.org/10.1016/j.chb.2008.06.003.
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KPM received support from MH018268-31 and receives support from K01DA042937. SJ received support from MH018268-33. MNP receives support from the Connecticut Council on Problem Gambling, and the Connecticut Department of Mental Health and Addiction Services. Beyond funding, the funding agencies had no further role in the writing of the report or in the decision to submit the paper for publication.
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Morie, K.P., Jackson, S., Zhai, Z.W. et al. Mood Disorders in High-Functioning Autism: The Importance of Alexithymia and Emotional Regulation. J Autism Dev Disord 49, 2935–2945 (2019). https://doi.org/10.1007/s10803-019-04020-1
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DOI: https://doi.org/10.1007/s10803-019-04020-1